What qualifications do you believe you have that would benefit our citizens should you be elected?

I love San Juan Island, care about our rights as patients and taxpayers, and understand how to work through complex issues. I also have strong business skills, strong communication skills, and a strong commitment to public service plus a blend of private, nonprofit, and public sector experience. I’ve also managed many long-term multi-million dollar service contracts and I know how to work fairly with vendors and hold them accountable for results.

Before becoming a Patient Advocate, I helped start two successful technology companies (Valve, Picnik), worked as a Senior Policy Officer at the Bill & Melinda Gates Foundation where I worked directly with Bill and Melinda, and spent 11 years at Microsoft in senior marketing and business development roles. I’ve also worked pro bono for nonprofit organizations (NetHope, Code for America) that are leveraging technology to make international nonprofits and local governments here in the U.S. more effective and efficient.

I also have EMS experience as a seasonal National Park Service Ranger at Crater Lake, where part of my responsibilities was dispatching and coordinating communications among law enforcement and emergency response teams in a geographically isolated environment with thousands of visitors daily.

Plus, I’m an instrument-rated pilot, which means I understand the air transport challenges in an environment where the weather doesn’t always cooperate.

What issues do you believe face the hospital board once all positions are filled?

I see three major near-term issues:

We need to build a sustainable, trustable budget for EMS that can win community support.

We need to ensure the Public Hospital District continues to have ongoing oversight and control of our local tax dollars now and into the future.

We need to minimize our legal exposure and find a pragmatic solution to the concerns raised by the American Civil Liberties Union.

With respect to Item 1, Islanders love our emergency responders, but we want to see a budget and budgeting process that ensures we’re all treated fairly, both as patients and taxpayers.

Given the defeat of two previous EMS levies, the Public Hospital District needs to help EMS build a bottoms-up budget without preconceptions that the community will ultimately trust and support. I’ve done this type of budgeting multiple times and faced scrutiny from some very tough bosses. I understand the inherent and nuanced decisions that will come into play and I want to work toward a transparent and fair budget that ensures we’re being smart with our public tax dollars.

With respect to Item 3, because of PeaceHealth’s refusal to provide certain reproductive health services, the exclusive 50-year contract with PeaceHealth has put the District into an untenable situation. Either the public hospital district denies funding for any and all pregnancy-related health services for 50 years or it violates WA’s Reproductive Privacy Act. This is a public policy failure and legal quagmire that must be addressed. In my view, we should study what worked in Jefferson County, where a task force of experts pragmatically worked through the issues and came up with specific recommendations, since adopted by the public hospital district board, to bring the PHD into compliance with the law and better serve patients.

Why or why not should the public hospital district revisit the basic contract with PeaceHealth?

The contract with PeaceHealth needs to be amended so that the public hospital district can comply with the law and better serve the public.

The public, through its elected officials, should always maintain oversight and control over long-term service contracts, especially in a situation where a given contract lasts 50 years. As a community, we should decide on an ongoing basis what services we want to fund and support.

Unfortunately, the Public Hospital District turned over all oversight and control of our public dollars to PeaceHealth for a 50-year period and effectively granted PeaceHealth the right to decide what services will be delivered with our tax dollars.

The American Civil Liberties Union has warned that the San Juan Public Hospital District is violating Washington State law. The public hospital district should absolutely fund pregnancy-related health services, just as it did when Inter Island Medical Center was operating. This doesn’t mean babies should regularly be born on the island, any more than it did when Inter Island Medical Center was operating. However, as both a moral issue and as a common sense issue, we should be funding essential prenatal and other pregnancy-related health services, and support providers who deliver those services to island residents.

I also believe that the 75% of island voters who supported WA’s Death with Dignity Law want access to those services on San Juan Island. We should be able to fund services to help terminal patients access Death with Dignity services regardless of PeaceHealth’s (legal) refusal to participate in any way with the Death with Dignity Act.

Who should have oversight for services at PeaceHealth PIMC that receive public funding from San Juan County?

Ultimately, the Public Hospital District serves the public and in that role, it needs to have oversight for how, when, and where tax-supported services are delivered now and into the future.

As someone who’s managed many long-term multi-million dollar service contracts at both Microsoft and the Gates Foundation, I can’t conceive of a 50-year exclusive contract for services where all oversight authority, including the ability to decide what services will and won’t be offered, resides with the vendor providing the services. Yet this is the situation we find ourselves in here on San Juan Island.

At its heart, the agreement with PeaceHealth is a subsidy-for-services agreement. The San Juan Public Hospital District, representing the community, should determine on an ongoing basis what services it wants to fund, and establish rational parameters for how those services will be delivered.

For services that the District wishes to fund, but that PeaceHealth chooses not to deliver, or in situations where PeaceHealth underperforms in delivering the services, the SJPHD should have the right to fund services elsewhere. This is common sense and is the type of framework that makes long-term service contracts work for both parties.

All vendors the District funds should manage service delivery on a day-to-day basis, but it’s crucial that the District be able to step in and demand a remedy when a vendor/provider is either not performing or is underperforming.

How do you see the interplay between voter-approved initiatives and the Religious and Ethical Directives for Catholic Health Care which PeaceHealth indicates they follow?

The Death with Dignity Act and the Reproductive Privacy Act were both enacted into law through a vote of the people and overwhelmingly supported on San Juan Island. We have to follow those laws; not following them is not an option.

We also need to respect the separation of Church and State, which is written into Washington’s State Constitution.

The Ethical and Religious Directives (ERDs) for Catholic Health Care were established by the Catholic bishops, and apply to all Catholic health care ministries, including PeaceHealth. The ERDs forbid some health services and require others. Forbidden under the ERDs are many reproductive health services and any participation with Death with Dignity.

A public entity, funded with our tax dollars, should never be bound by, nor should it be limited by, rules governing a private religious ministry.

Keep in mind that many religions and religious entities have specific rules that can come into play in the realm of medicine. Examples of these types of rules: No sterilization, no birth control, no blood transfusions, no abortion, no porcine-based (pig) medicines or surgical procedures utilizing pig parts, no amputations, no unaccompanied women in the presence of a male physician, genital circumcision (mutilation) required for young women, no treatments based on fetal stem cells or derived from stem cell research, no mental health care. Some religions deny the need for health care interventions entirely.

By entering into an exclusive 50-year contract in which 97% of all available funding goes to a specific religious ministry, the San Juan Public Hospital District effectively made all of us subject to a specific religion’s rules. Health services, including reproductive health care services and end-of-life services, cannot and should not be limited because a religious entity objects to providing them.

If PeaceHealth won’t deliver certain services that the community wants and needs, the public hospital district should be able to fund those services separately.

Can you talk more about Emergency Services? What experience do you bring that would help make our EMS better?

In addition to lots of management experience overseeing multi-million budgets, I have boots-on-the-ground experience as an emergency response dispatcher dating back to when I was an NPS ranger at Crater Lake National Park. Crater Lake actually shares some attributes that make it similar to San Juan Island, except Crater Lake has bears!

The NPS rangers were responsible for law enforcement, emergency medical services, search and rescue, wildland and structural fire-fighting, as well as visitor safety, assistance and information. My primary job during my summers there was to provide dispatch services, including communications coordination, for all of the rangers engaged in those activites. The nearest hospital was a minimum of 90 minutes away even when the roads were clear. Because accidents so often happened in more remote areas of the Park, we had to plan for longer time frames and stabilize patients for long-distance transport.

I’m also an instrument-rated pilot, so I understand the issues involved with trying to fly when weather conditions deteriorate. The isolation and sometimes sketchy fying weather here present key challenges, and I’m looking forward to working with EMS to ensure we’re providing quality, cost-effective services.

The average gross revenue for an in-patient visit at PeaceHealth is now more than $1100. Why have costs gone up so fast and so far?

I have some ideas on how and why costs have gone up, but in order to fully understand, we have to be able to ask questions and get some answers and we need ongoing, effective oversight.

In some cases, I believe the requirements of PeaceHealth’s business model have taken precedence over what makes sense for patients.

As one example, in public testimony before the County Board of Health, representatives from the SJPHD and from PeaceHealth insisted that if a patient was routed into the emergency room, then the presumption MUST be that the patient has a life-threatening emergency. Even if the reason the person is routed into the emergency room is simply because PeaceHealth doesn’t have any Urgent Care appointments available. This is a scheduling problem and business model problem, not a health care problem, but it is how and why an earache or a cut requiring stitches can result in billings of $1500 or more.

We need an Urgent Care model that makes sense for people who live on an island and we need Emergency Care for people facing life-threatening emergencies. The SJPHD should support models that work and cut off funding to models that don’t.

We also need a coordinated, integrated Primary Care model so that patients can see a physician on-island who provides primary care, who also coordinates care with specialists in a way that makes sense. If your cancer is best treated by an expert at UW or the Cancer Care Alliance or Virginia Mason, your on-island physician should be able to work with that physician. You shouldn’t be forced to see specialists at PeaceHealth or any specific vendor/provider in order to get coordinated on-island care.

Similarly, if you’re a pregnant woman, for the health of your baby and yourself, care needs to be available on-island throughout your pregnancy and it should be coordinated closely with the physician or midwife who will be present at the delivery.

Above all, we need a cost structure that maps to the health care needs of islanders, understanding that some services are only going to be available at much larger facilities off-island.

You’ve said that PeaceIsland restricts certain services. What do you mean?

All PeaceHealth facilities, as Catholic health care ministries, follow the Ethical and Religious Directives (the ERD’s) for Catholic Healthcare. The ERDs are rules, promulgated by the United States Conference of Catholic Bishops, that restrict what services can and can’t be provided.

The ERD’s restrict some services and require others. Restricted services include contraception, fertility treatments, pregnancy termination even when a woman’s life is at stake, any treatments based on embryonic stem cells (which have shown promise in treating diseases including MS and rheumatoid arthritis), and any participation in Death with Dignity. Physicians are even forbidden from providing a referral to a physician who will support a patient’s right to access Death with Dignity.

Among the services required by the ERDs is tube feeding for patients in a persistent, vegetative coma. This rule was implemented by the U.S. Conference of Catholic Bishops after the Terri Schiavo case. Note that this requirement applies in Catholic health systems regardless of what your Advanced Directive might say.

In Washington State, women who were actively miscarrying have been denied appropriate care, likely because physicians were worried that pregnancy termination might violate the ERDs, which can be a firing offense. Researchers at the University of California at San Francisco have documented these issues here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636458/

PeaceIsland is very clear about its policies, including the policy that says it will not follow Advance Directives that conflict with Catholic doctrine:

You can read more about PeaceHealth policies here: http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalPolicies

But we were told PeaceHealth isn’t as strict as some other religious providers and that the relationship between the physician and patient is kept private. Doesn’t this protect us?

The contract gives PeaceHealth complete latitude to provide only those services that fit its mission and values. This is a problem when the stated mission of Catholic health care ministries is to provide witness to the Catholic faith.

Health care is health care. We should be supporting health care services that make sense for islanders regardless of whether PeaceHealth wants to provide those services or not.

The Washington State Constitution is very clear that public money cannot be used to support a religious mission. The ACLU, citing the Washington State Constitution, has said that the contract between PeaceHealth and the SJ Public Hospital Taxing District is unlawful, and they have already filed suit in Skagit Valley to force the public hospital district there to comply with Washington’s Reproductive Privacy Act, which was enacted into law through a vote of the people.

The legal issues are serious and the public hospital taxing district has a legal and fiduciary responsibility to ensure it is following State law. The consequences of violating the law are serious and need to be addressed proactively; the alternative is costly litigation with unpredictable financial consequences.

The San Juan Public Hospital District can ensure we’re following the law by making sure that we’re funding health care services based on what islanders want and need, not what PeaceHealth (or any other provider) decides it wants to deliver. This is an important distinction.

But does it make sense for women to get prenatal care on San Juan Island through the public hospital district even though PeaceHealth has decided not to provide it?

Yes it does. Already in 2015, we’ve had at least three emergency deliveries on-island because women couldn’t be moved off island in time. Family medicine providers are specifically trained to provide prenatal care and there’s no reason essential prenatal services shouldn’t be available on-island and subsidized through our hospital taxing district, just as they were when Inter Island Medical Center was operating.

Very recently, Christine Dehlendorf, M.D., who graduated first in her class from the UW Medical School, and who now practices and teaches Family Medicine at the University of California, San Francisco, assured the public hospital district commissioners in a public meeting that family medicine physicians have the skills and training appropriate to treat pregnant women. For many women, it’s still going to be safer to deliver off-island, where patients have access to a broader range of emergency services, but it makes no sense for the public hospital district to refuse to subsidize essential prenatal services even as it subsidizes physician services for a broad range of other conditions. Subsidies are important because approximately two-thirds of the women giving birth in San Juan County are low income, and many of them work multiple jobs which make off-island travel difficult. We need to make prenatal care more accessible, not less.

Your critics try to characterize you as extreme. What do you say about that?

I’m a pragmatist, with lots of experience bringing disparate groups together to solve important problems. At Microsoft, I managed large teams and won the division-wide Market Maker Award for helping to build Microsoft’s business around the world. I also helped build two very successful technology companies, Valve and Picnik. As a Senior Policy Officer at the Bill & Melinda Gates Foundation, I worked directly with Bill and Melinda and helped to build and then manage the central communications team. And later, I served as a probono advisor to the CEO of NetHope, which is a collaborative non-profit that brings together senior technical leaders from more than 30 global nonprofits including the International Red Cross, Save the Children, and the World Wildlife Fund, all to leverage and share technical and communications resources smartly in order to improve program delivery and coordinate emergency response around the globe.

My goal is to see that essential health care here on San Juan Island is delivered cost-effectively, that we’re following the law, and that our public dollars are unrestricted by any particular religious viewpoint. We can make our health care system better and I’m committed to making that happen.

You’ve been endorsed by the San Juan County Democrats. Why did you seek party endorsements in this non-partisan election?

A non-partisan election is one where candidates don’t declare a party preference on the ballot. However, endorsements in non-partisan elections are common. As an example, in the most recent election for Public Hospital District Commissioner, Republican Party Chair Michelle Loftus, in her official capacity, expressed a clear preference for one candidate over another.

I believe in transparency and I welcome endorsements from anyone who shares my views on key issues, which includes much stronger ongoing oversight of our tax dollars and support for Washington’s Reproductive Privacy Act and Death with Dignity laws. I sent letters to the chairs of both major parties on San Juan Island, outlining my views on key issues, explaining more about my background, and informing them I welcomed endorsements from people and organizations who are committed to protecting the rights Washington voters secured under both the RPA and DWD laws. The San Juan County Democrats endorsed my candidacy. I did not hear back from anyone in the Republican Party.

Elect Monica Harrington• San Juan Island Public Hospital District Commissioner